Abstract
ObjectiveHand, foot, and mouth disease (HFMD) has posed a great threat to the health of children and become a public health priority in China. This study aims to investigate the epidemiological characteristics, spatial-temporal patterns, and risk factors of HFMD in Guangdong Province, China, and to provide scientific information for public health responses and interventions.MethodsHFMD surveillance data from May 2008 to December 2011were provided by the Chinese Center for Disease Control and Prevention. We firstly conducted a descriptive analysis to evaluate the epidemic characteristics of HFMD. Then, Kulldorff scan statistic based on a discrete Poisson model was used to detect spatial-temporal clusters. Finally, a spatial paneled model was applied to identify the risk factors.ResultsA total of 641,318 HFMD cases were reported in Guangdong Province during the study period (total population incidence: 17.51 per 10,000). Male incidence was higher than female incidence for all age groups, and approximately 90% of the cases were children years old. Spatial-temporal cluster analysis detected four most likely clusters and several secondary clusters (P<0.001) with the maximum cluster size 50% and 20% respectively during 2008–2011. Monthly average temperature, relative humidity, the proportion of population years, male-to-female ratio, and total sunshine were demonstrated to be the risk factors for HFMD.ConclusionChildren years old, especially boys, were more susceptible to HFMD and we should take care of their vulnerability. Provincial capital city Guangzhou and the Pearl River Delta regions had always been the spatial-temporal clusters and future public health planning and resource allocation should be focused on these areas. Furthermore, our findings showed a strong association between HFMD and meteorological factors, which may assist in predicting HFMD incidence.
Highlights
Hand, foot, and mouth disease (HFMD), mainly caused by the enteroviruses virus, has resulted in major outbreaks across the world in the past three decades [1]
The clinical criteria for diagnosis of HFMD cases was provided in a guidebook published by the Ministry of Health (MOH) in 2008 [7], in which patients were defined as HFMD with occurrence of the following symptoms: fever, papules and herpetic lesions on the hands or feet, rashes on the buttocks or knees, inflammatory flushing around the rashes and little fluid in the blisters, sparse herpetic lesions on oral mucosa
Demographic Characteristics Between May 1, 2008 and December 31, 2011, there are a total of 641,318 HFMD cases reported to the China National Public Health Surveillance System of Guangdong Province
Summary
Foot, and mouth disease (HFMD), mainly caused by the enteroviruses virus (especially coxsackievirus A16 and enterovirus 71), has resulted in major outbreaks across the world in the past three decades [1]. The disease is usually mild and selflimiting, but sometimes serious neurological and cardiopulmonary complications may occur in HFMD outbreaks, when the causative virus is enterovirus 71 [3,4]. In 2008, a large wave of HFMD epidemics occurred in mainland China, Taiwan, Malaysia, Singapore, Hong Kong, etc. In mainland China, epidemics started in Fuyang City, Anhui Province, resulting in 353 severe cases and 22 deaths, and rapidly developed into a national-scale epidemic, covering 28 provinces within 3 months with 345,159 reported cases (accounting for 70.59% of the total reported cases of the year) [5,6]. According to the national network’s surveillance data, a total of 5,031,044 cases were officially reported in China during May 2008 to December 2011
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